The discovery of antibiotics had been one of the most significant events in the history of medicine. Antibiotics had saved countless number of lives and had contributed significantly to the health of mankind. The emergence of resistance is however a major threat to the continued usefulness of antibiotics. There are now strains of bacteria which are resistant to virtually all available antibiotics and these strains are increasingly being encountered in clinical practice. The development of new agents had not kept pace with resistance and it is unlikely that there will be major breakthroughs in the near future. The world needs to conserve and prolong the useful lives of the existing agents. This can only be achieved through good antibiotic stewardship programmes. As antibiotic resistance is a global threat all major stakeholders have to work together to meet this challenge.

Consent is defined as the “voluntary agreement to or acquiescence in what another person proposes or desires”. In the context of medical practice it is now universally accepted that every human being of adult years and of sound mind has the right to determine what shall be done with his or her own body. Informed consent is now a central part of medical ethics and medical law. There has been a change in the public’s expectations of their role in medical decision making. The paternalistic approach by doctors is no longer acceptable. Today the patient has the right to receive and the doctor the obligation to give sufficient and appropriate information so that the patient can make an informed decision to accept or refuse a treatment option. This has led to higher standards of practice in the process of informed consent taking. Consent taking is both a legal and moral requirement. Failure to comply with standards of practice can result in criminal prosecution, civil litigation or disciplinary action by the relevant professional authority. Consent taking is a process and not merely a one-off affixation of the patient’s signature on a consent form. It involves a continuous discussion to reflect the evolving nature of treatment from before the treatment is given to the post-operative or discharge period. The regulatory authorities in many countries have established standards for consent taking which would include the capacity of the patient, the person who should seek consent, the information to be provided and the necessary documentation.
Informed Consent

Wounds and Injuries/*mortality

Malaysia/epidemiology ; Neoplasms/*epidemiology ; Neoplasms/therapy

Leptospirosis is a re-emerging zoonotic infection. In developing countries large outbreaks have occurred in urban slums and following fl oods. Individuals from developed nations are also now more frequently exposed to the infection as a result of international travel and greater participation in certain outdoor recreational activities. Leptospirosis remains a diagnostic challenge since it often presents as a non-specifi c febrile event and laboratory diagnosis is still currently inadequate. Rapid tests may not be suffi ciently sensitive in early disease and culture facilities are not widely available. A severe pulmonary haemorrhagic form of the infection is increasingly being encountered in many countries including Malaysia. The control of leptospirosis is largely dependent on general hygienic measures and rodent control. An effective human vaccine is still not available. There remains much that is unknown about this disease and there is scope and opportunity for good quality research.

This allegorical poem describes the fears and uncertainties faced by the author in the COVID-19 circuit breaker period, from compliance to health advisories as understanding of the contagion evolved, from conflict of responsibilities to family, patients and teaching, and from managing the CME points requirements of the resilience webinars. Four bonsai compositions of legendary Chinese figurines are used as metaphors for the themes of the webinars.

Osteoporosis is a common ailment, especially in older women, yet it is one of the most under-diagnosed and undertreated diseases. Screening of patients, therefore, is invaluable to identify those who require further evaluation. We shall discuss who requires screening and further evaluation of osteoporosis and discuss the diagnosis of osteoporosis.

The rate of overweight and obesity is increasing worldwide, with significant health impact. Obesity is a risk factor for morbidity and mortality and weight loss should take a multi-pronged approach, including dietary control and physical activity. The lack of physical activity, sedentary behaviour, as well as poor cardiorespiratory fitness are all independent risk factors for morbidity and mortality as well, thus it is important to advise lifestyle changes to address these issues. Most individuals who have no contraindications can embark on light- to moderate-intensity physical activity without the need for medical clearance. Specific advice on physical activity should be given, targeting the individual, and this can be done using the FITT (frequency, intensity, time, type) principle. Physical activity should also be reviewed regularly and progressed gradually to target physical activity guidelines. Individuals should also be encouraged to replace sedentary behaviour with at least light-intensity physical activity whenever possible.

No abstract available.
Chimerism ; Hematopoietic Stem Cells

Uncontrolled blood pressures (BPs) lead to progressive or impending end-organ dysfunction (EOD), which falls under the category of hypertensive emergencies or hypertensive crisis. In these conditions, the BP should be lowered aggressively over minutes to hours. Neurologic end-organ damage due to uncontrolled BP may include hypertensive encephalopathy, cerebral vascular accident/cerebral infarction; subarachnoid hemorrhage, and/or intracranial hemorrhage.[1] Cardiovascular end-organ damage may include myocardial ischemia/infarction, acute left ventricular dysfunction, acute pulmonary edema, and/or aortic dissection. Other organ systems may also be affected by uncontrolled hypertension, which may lead to acute renal failure/insufficiency, retinopathy, eclampsia, or microangiopathic hemolytic anemia. With the advent of antihypertensives, the incidence of hypertensive emergencies has declined from 7% to approximately 1% of patients with hypertension.